BOB in Ped Surg 2023 - PAPS Winner - Jamie Schnuck, MD

All right. I know Tony has four minutes left until he has to leave and it's perfect timing to get us into the final heat which is the Pacific Association of Pediatric Surgery. Exactly. So, we already had nine. This is the last one before our final and, well, I'm very excited. So, first for this, we have, uh, Dr. Francois Alini Dasie from Stanford School of Medicine with increasing amount of hair reduction using laser correlate to lower probability of recurrence in patients with pilodialysis. This is a retrospective observational study and they aim to evaluate if hair reduction, uh, achieved using laser could correlate with lower chances of pil dialysis recurrence. Then we have Dr. Shaymi Schnuk, um, she's a doctor from the University of Washington, presenting test tube management following lung recession in pediatric patients, a retrospective analysis. And as the title says, this is a retrospective study including patients from 2013 to 2020 that aim to clarify the utility of test tube placements during lung resections and establish a protolized approach to eliminate them from routine procedures. Um, and third is Britany Hats, that's a pediatric surgeon from uh, sorry, it's a pediatric surgery research fellow from the University of Texas, Houston with impact of cryoalgesia used for pain control in minimally invasive Pectum repair in hospital cost of point of. So this is a retrospective study that includes patients treated with minimally invasive uh repair pectum and cryoalgesia from 2011 to 2021 and their aim to evaluate the impact that cryoalgesia had in total hospital cost. So, well, there are three great presentations that pops brought to us today and let's see what the pool says. All right. Now that we're using the comfort one product, the the smoothness and the transition from going from the pre-operative area, which is pretty unthreatening in most cases, into the operating room has really improved. Not only for the child, but for the parent. You know, we let the parents come back um with the children when we in most cases, when it's not an emergency, when we induce them to sleep. And that's a really high anxiety time for everybody and and there can be a lot of stress involved with it. And with the comfort one product, we're now able to kind of engage the child and the parent in that video environment that kind of really separates them from what's going on around them. They become less focused on uh the nurses and the doctors and the anethesist and and the things that are very scary for both the parent and the child and more in the experience that the child's having in terms of the video they're watching, gradually going off to sleep. Um and it's really a much a much better situation. By having this kind of joint uh stimulus for both the the child and the parent, it really is a much kinder way of of putting them to sleep and allowing them to get ready, you know, for the next stage of the procedure. And that affects I think the operating room team too because when we have to try and put a child to sleep who's very stressed, I think it stresses out the nurses, it stresses out the anethesist, it stresses out the physicians. You know, my personal experience is to be there as a child's being induced and watch so that it's no longer a scary experience has really made a difference. Okay, so we are back and the pool says, um, that the video we are going to see today is from Dr. Jamie Snuk is, um, testive management following lung resection in pediatric patients, a retrospective analysis. So if we have the video, let's see. I think Hello. My name is Jamie Schnuk and I'm currently a general surgery resident at the University of Washington. Thank you for listening to my presentation entitled Chest tube management following lung re section, a retrospective analysis. Plural drainage is nearly universally practiced in pediatric patients following lung re section, and it's often associated with increased pain, anxiety, subjecting the patients to additional chest x-rays, and may even prolong hospitalizations. We've seen in the adult literature that the elimination of routine chest tubes as a part of enhanced recovery after surgery pathways or eras in select patients. We sought to clarify the utility of routine chest tube placement during pulmonary wedge resection or lobectomy in pediatric patients, and ultimately guide development of a protolized approach to eliminate routine plural drainage in select patients undergoing lung resection altogether. We performed a retrospective chart review of all patients less than 21 years of age who underwent either pulmonary lobectomy or wedge resection at one academic Children's Hospital. Patients who underwent wedge resection for a spontaneous pneumothorax were excluded. 130 procedures met inclusion criteria and were subsequently divided into three groups. Group one included 59 patients who underwent lobectomy. Group two had 19 patients who underwent a diagnostic wedge resection for an unknown underlying lung disease. And group three included 52 patients who had an excisional wedge resection for oncologic disease with concern for metastasis. You can see our variables that we included here. In group one, 59 patients who underwent lobectomy, nearly 75% of these patients did not have an air leak noted post-operatively, and their median chest tube duration was two days. There were 15 patients who did have a documented air leak, and their median chest tube duration was two days as well. Of the 19 patients who underwent a diagnostic wedge resection, nearly 90% of patients did not have an air leak noted post-operatively, and median chest tube duration was one day. Of the remaining patients with a documented air leak, it only lasted for one day and their chest tubes were removed on post-op day two. In group three, patients who had an excisional wedge resection, 80% of patients did not have an air leak noted post-operatively, and median chest tube duration was one day. Of the remaining 10 patients who did have an air leak, median chest tube duration was two days. Overall, 43% of patients had their chest tube removed on post-op day one. 22% had their chest tube removed on post-op day two, and a quarter of these patients had their chest tube left in place for a documented air leak. The remaining 35% of patients had their chest tube removed on post-op day three or later. So in conclusion, chest tube duration following lung resection in children is typically brief with removal within one to two days post-operatively. And we further postulate that avoidance of chest tube placement may reduce post-operative pain and hospital length of stay. Our future directions include developing an eras protocol following lung re section in pediatric patients with the standardization of a leak test, which would include placement of a temporary chest tube to evaluate the presence or absence of an air leak at the end of the case before the patient even leaves the OR. Hoping to eliminate chest tube drainage in a select group of patients altogether. Thank you for your time. All right, thank you. This was uh, sorry. No, it's okay. We are back. This was our final paper and uh unfortunately Dr. Schnuck is not able to join us. But we'll have a brief discussion and then we are going to go to the poll to talk about who wins the the best of the best this year. Um, regarding this paper, we actually wrote a paper called Chest Tubes not necessary in wedge biopsies and um uh this was a cohort where no chest tubes were used and we saw that the outcomes were good. The the concern I have though with this concept is it's not necessarily the number of patients that don't need it. It's what happens to those that did need it that you didn't put a chest tube in. Um, are do they go I mean what would happen to those patients that did have a leak. I think that um, in the one study, I mean, in her study, she showed that um, or she she mentioned at the end the idea of doing like a leak test at the end and and I guess that even if there is a leak it would be small. Yeah. Um, yes, I think that it's not the same if it's a clean lobectomy or if it has, I don't know, a lot of like infections or those and and it depends on the surgery, but I think that many things are getting us towards doing less. So I think that we need to find those things that uh make us worry for the leaks to stop leaving test tubes to everyone. You know, it's like we now need to focus not in seeing if living or not a test tube is um feasible, but to see which patients uh will need it and just live them to them. Like not to everyone. Right. I mean go ahead. I just had one question, Todd. I was wondering for the patients who ended up needing it, you know, like I like you're saying the worry is like, you know, do they develop like tension pneumothorax later on and it's kind of more of an emergent like need for a chest tube. Um, I guess we you know, that would be one question I was going to ask as well. So, what about if we could instead of leaving a chest tube since the numbers are so small, we leave a tiny little pressure monitor. Uh, and and maybe you could start sensing a pneumothorax as a vital sign. Um, and say, oh, you know, the pressure is this and it gets an alarm and you can get a chest x-ray and see if there's an actual instead of putting a tube in, we can have a monitor instead of a tube, uh a live action monitor. Um, I That would be awesome. Right? Right. Right. Alan and Cecilia, you're on it. You got you got six months left and you got a year left to figure that out. All right.